Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 8/5/2024
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Information Technology
5) Department Contact: Misty Witmer
6) Description: Consideration of approval of installation/setup for the hosting of the CoreEMR application server with VitalCore Health Strategies LLC submitted by Information Technology
7) PEID No: 721661
8) Req No: N/A
9) Orgkey: 1101159100
10) Object Code: 5481000
11) Vendor: VitalCore Health Strategies LLC
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted: $365,045.00
16) Current Year Projected: $1950.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 6/1/2024
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: 8/5/2025
26) Contract # Issued by Purchasing Department: CM24250
NOTES: HB1295 Requested